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Vaccines, behavior changes behind 'encouraging' monkeypox numbers, doctors say

CDPHE reported almost half as many monkeypox cases in September as it did in August, the first time it recorded a decline since the outbreak began.

COLORADO, USA — An increase in vaccinations and an avoidance of risky sexual behavior are to credit for the first monthly decline in monkeypox cases recorded in Colorado since the outbreak began, the head of the Tri-County Health Department (TCHD) said. 

"It's too early to say we know where this is going for sure, but it is absolutely improving," said TCHD Executive Director Dr. John Douglas. 

The state's health department recorded 157 cases of monkeypox in August – a record high – compared to 82 cases in September.

In a statement, the Colorado Department of Public Health and the Environment (CDPHE) said its epidemiologists "remain cautiously optimistic about the recent monkeypox data." 

"These trends are consistent with what we are seeing in national data," CDPHE said. "While these numbers are encouraging, monkeypox is still in Colorado."

Douglas credited more widespread vaccination availability and eligibility for the decrease in cases but also said behavior changes have played a critical role. 

"The second part that I think has absolutely made a difference is changes in risky sexual behavior among men who have sex with men," he said. "The community is understanding what’s happening transmission-wise and, in addition to vaccines, are taking steps to reduce their exposure."

Credit: Photo illustration of CDPHE data

Anyone can get monkeypox – it is spread through close contact – but doctors are finding most cases in men who have sex with men. Douglas said he hopes people at the most risk continue to practice safe behaviors so monkeypox won't get the upper hand. 

It helps, he said, that monkeypox is a DNA-based virus, which is less likely than RNA-based COVID-19 to mutate into new variants. "I wouldn't rule out the development of changes that would make the vaccine less effective or treatments less effective, but I think they're a whole lot less likely with monkeypox than we've seen with COVID," he said. 

But Douglas said the decline in new cases has not happened equally across all demographic groups; new case rates are falling slower in communities of color. He hopes a recent expansion of vaccine eligibility will help reduce the stigma of the shot. "I’m hoping that that’s going to encourage more folks to get vaccinated," Douglas said. 

"Preliminary data from Centers for Disease Control and Prevention highlights the importance of vaccination — showing that eligible, high-risk populations who did not get vaccinated against monkeypox were 14 times as likely to get the disease than those who were vaccinated," CDPHE said. Vaccination is free and available at locations across the state.

Even with the data showing a decline in new cases, Douglas warned against becoming complacent in the face of a newly-spreading virus. "We don’t want to be alarmist, but we do think there are plenty more people that could benefit from getting the vaccination," he said. "These positive trends that we’ve seen recently could reverse themselves." 

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